a sourcebook of hiv/aids prevention programs volume 2

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Primary School Action for Better Health, Kenya 121HIV education in a changing cultural contextTraditionally, discussing sex openly was taboo. Grandparents, however, advised the youth aboutcultural norms and taught them that sex was ‘sacred.’ The interaction between communitiesand the outside culture has since changed this culture. The media also played a great partin change.PSABH lead trainerMessages delivered need to be clear, honest and consistent. Young people are particularlyattuned to picking up a range of views as they try to develop their own characters and ways insociety. Unless messages are consistent with those of other key players such as politicians,religious leaders and media personalities, it is more difficult to achieve a sustained impact.PSABH managerFor HIV education to be effective, full knowledge of the culturally specificfactors affecting both transmission and the delivery of health messagesis vital. Well-researched, up-to-date knowledge is particularly important ina time of rapid cultural change.PSABH was based on an understanding of the culture in which Kenyanchildren and teachers live. It also reflects understanding of how educationworks in Kenya, how schools work, how the education system functions,and how schooling forms and modifies behavior.Research conducted at all stages of the program has enabled constantattention to be paid to the knowledge, attitudes, and behavior of school-agechildren in Kenya; the course of the HIV epidemic; and the impact of theprogram. Such attention has led to continuing evolution of the aims, nature,and delivery of activities to ensure their maximum impact in preventingHIV infection. Research has also been important in helping advocates pushfor continuance and expansion of the program. It has shown skeptics thattheir fears of the program were unwarranted.MethodologyMethods used for data collection included self-completed questionnaires(completed by head teachers and students); in-depth interviews (of teachersand community members); focus group discussions (of students); and surveysof school and community responsiveness (based on zonal inspectors’visits). Data were collected before the program was introduced, 14–18months after teachers were trained, and 26–30 months after training. 4 Theevaluation surveyed 10,000 students, 700 head teachers and teachers, and 68local leaders and community representatives. It included 116 schools inwhich PSABH was in place and 62 control schools.The survey and interviews focused on the following issues:(c) The International Bank for Reconstruction and Development / The World Bank
122 A Sourcebook of HIV/AIDS Prevention Programs, Vol. 2• Knowledge about transmission and prevention of HIV• Attitudes toward risk and prevention• Teaching and activities in school• Sexual behavior (students only)• Attitudes toward sexual, gender, and cultural issues• Community behavior and activities.ResultsAt 18 months the program showed the following impressive results in targetschools (table 6.1):• Sexual initiation among both boys and girls was delayed.• Fewer boys and girls reported they had ever had sex.• More girls reported having been forced to have sex.• More boys reported avoiding places in order not to have sex.• More girls reported condom use during last sexual encounter.• More girls felt they could say no to sex.Table 6.1: Odds Ratios for Impact of Interventions on Student Behavior and AttitudesITEM BOYS GIRLSEver had sex 0.80** 0.86**Had first sexual experience in past year 0.62*** 0.60***Ever forced to have sex 0.90 1.15*Ever avoided a place to avoid sex 1.35** 1.07Used condom during last sexual encounter 1.07 1.53**Can definitely say no to sex 1.07 1.30**Can definitely have a boyfriend or girlfriend and not have sex 1.20* 1.30**Can definitely tell boyfriend or girlfriend that I prefer to waituntil I am married to have sex 1.15* 1.25**Definitely believe “no” means “no” 0.90 1.20**Source: Cf BT.* Significant at the 5 percent level. ** Significant at the 1 percent level. *** Significant at the 0.1 percent level.Note: Odds ratios compare the size of the changes among the student population in the target schools and those in control schools,taking account of the baseline difference between the target and control groups. An odds ratio of 1 represents no differencebetween target and control schools, a ratio greater than 1 represents an increase in target schools, and a ratio less than 1 representsa decrease in target schools. The farther the ratio is from 1, the larger the change. An odds ratio of 0.60 for girls’ sexualinitiation indicates that the net gain in delaying first sexual encounter in the year before data collection for girls in target schoolscompared with control schools is 37.5 percent.(c) The International Bank for Reconstruction and Development / The World Bank
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A SOURCEBOOK OF HIV/AIDSPREVENTION
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© 2008 The International Bank for
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viContents4 The School Health Educa
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viiiContentsTables7.1 Impact of Sug
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xiiAcknowledgmentsKelly (University
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xviAbbreviationsNASNERDCNGONIEDNSGA
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xviiiIntroductionTable 1: Program D
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xxIntroductionhttp://unesdoc.unesco
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Chapter 10Key evaluation results: E
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Table A.1: Overview of Programs in
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236 Indexcivil society organization
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238 IndexGhana AIDS Commission (GAC
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240 Indexmaterialsin ELPE Program (
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242 IndexOlatunde, Bunmi, 203Oren,
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244 IndexRapid Results Initiative (
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246 Indexmaterials needed by teache
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ECO-AUDITEnvironmental Benefits Sta
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